3. New Classifications Flashcards
2018 CLASSIFICATION FOR PERIODONTAL AND PERI-IMPLANT DISEASES AND CONDITIONS
Workgroup 1: ____ health and gingival diseases and conditions
Workgroup 2: ____
Workgroup 3: Other conditions affecting the ____
Workgroup 4: ____ diseases and conditions
periodontal
periodontitis
periodontium
peri-implant
Periodontal Health, Gingival Diseases and Conditions
- ____ and gingival health
- gingivitis: dental ____-induced
- gingival diseases: ____-dental biofilm-induced
periodontal
biofilm
non
Workgroup 1
Four categories of periodontal health
1.1 ____ periodontal health (rare but realistic)
Total absence of clinical inflammation
pristine
Workgroup 1
- 1 Pristine periodontal health (rare but realistic)
- No ____, edema or pus
- Probing ≤ ____ mm (PD)
- No ____ on probing (BoP)
- No ____ (AL)
- No ____ loss
erythema 3 bleeding attachment loss bone
Workgroup 1
1.2 Clinically periodontal healthy:
Absence or minimal levels of clinical inflammation
- Probing ≤ ____ mm (PD)
- ____ bleeding on probing (BoP) < 10%
- No ____ (AL)
- No ____ loss
3
minimal
attachment loss
bone
Workgroup 1
1.3 Periodontal disease stability:
Absence or minimal levels of clinical inflammation
- Probing depth ≤ ____ mm (PD)
- ____ bleeding on probing (BoP) < 10%
- ____ (AL)
- ____ loss
4
minimal
attachment loss
bone
Workgroup 1
1.3 Periodontal disease stability:
Successfully periodontal ____
Optimal reduction of ____, AL, minimal BoP
Lack of ____ destruction
treated
PPD
progressive
Workgroup 1
1.4 Non-periodontitis patient:
Systemic disease affecting the periodontium
- Probing depth ≤ ____ mm (PD)
- ____ bleeding on probing (BoP) < 10%
- ____ (AL)
- ____ bone loss
3
minimal
attachment loss
possible
Workgroup 1
____ categories of plaque-induced gingivitis and modifying factors
three
Workgroup 1
2.1 Associated with dental biofilm only: Due to bacterial \_\_\_\_ accumulation \_\_\_\_ response of the gingival tissues Most \_\_\_\_ form of periodontal disease Begins at the \_\_\_\_ Extend to the remaining gingival unit
plaque
inflammatory
common
gingival margin
Workgroup 1
\_\_\_\_ with tooth brushing / in saliva \_\_\_\_ Gingival \_\_\_\_ Erythema \_\_\_\_ No \_\_\_\_ loss No \_\_\_\_ loss
bleeding tenderness swelling halitosis attachment bone
Workgroup 1
Intensity of signs and symptoms:
- Vary among ____
- Vary among sites within a ____
Control of gingival ____ is essential for the primary prevention of periodontitis
individuals
dentition
inflammation
Workgroup 1
- 2 Potential modifying factors of plaque-induced gingivitis
- ____ conditions
- ____ enhancing plaque accumulation
systemic
oral factors
Workgroup 1
2.2 Potential modifying factors of plaque-induced gingivitis:
Systemic conditions: Sex steroid hormones - \_\_\_\_ - Menstrual cycle - \_\_\_\_ - Oral contraceptives
____
Leukemia
____
Malnutrition
puberty
pregnancy
hyperglycemia
smoking
Workgroup 1
2.2 Potential modifying factors of plaque-induced gingivitis:
Oral factors enhancing plaque accumulation
- Prominent ____ restorations margin
- ____
- Pregnancy ____
subgingival
hyposalivation
gingivitis
Workgroup 1
- 3 Drug influenced gingival enlargements:
- Antiepileptic: ____ and sodium valproate
- Calcium channel blocking drugs: ____, verapamil, amlodipine
- Immunoregulations drugs: ____
- High-dose ____
phenytoin
nifedipine
ciclosporine
contraceptives
Workgroup 1
2.3 Drug influenced gingival enlargements:
Extent:
- ____ (single tooth or group of teeth)
- ____ (throughout the dentition)
Severity:
- ____ (enlargement of papilla),
- ____ (papilla and marginal gingiva)
- ____ (extends to the attached gingiva)
localized
generalized
mild
moderate
severe
Workgroup 1
Plaque-induced gingivitis (all 3 categories)
Extent:
- ____ < 30%
- ____ ≥ 30%
localized
generalized
Workgroup 1
Plaque-induced gingivitis (all 3 categories)
Severity: gingival index by Loe (1967)
0
Gingival status: ____ gingiva
Crtieria: Natural color ____ gingiva
No ____
1 Gingival status: \_\_\_\_ inflammation Crtieria: Slight changes in \_\_\_\_ Slight \_\_\_\_ No \_\_\_\_ on probing
2 Gingival status: \_\_\_\_ inflammation Crtieria: \_\_\_\_ \_\_\_\_ and glazing \_\_\_\_ upon probing
3 Gingival status: \_\_\_\_ inflammation Crtieria: Marked \_\_\_\_ and edema \_\_\_\_ Spontaneous bleeding
normal
pink
inflammation
mild
color
edema
bleeding
moderate
redness
edema
bleeding
severe
redness
ulceration
Workgroup 1
3.1 genetic/developmental disorders
____ (HGF)
hereditary gingival fibromatosis
Workgroup 1
3.2 Specific infections
Bacterial origin: ____
Viral origin: ____ 1⁄2, HPV Fungal origin: ____
streptococcal gingivitis
herpes simplex
candidiasis
Workgroup 1
3.3 Inflammatory and immune conditions and lesions Hypersensitivity reactions: ____ allergy
Autoimmune diseases of skin and mucous membranes: ____, lichen planus, lupus erythematosus
Granulomatous inflammatory conditions: ____
contact
pemphigus vulgaris
sarcoidosis
Workgroup 1
3.4 Reactive processes
____
Peripheral giant cell granuloma
____
pyogenic granuloma
central giant cell granuloma
Workgroup 1
3.5 Neoplasms
____: leukoplakia, erythroplakia
____: squamous cell carcinoma
premalignant
malignant
Workgroup 1
3.6 Endocrine, nutritional, metabolic diseases \_\_\_\_ deficiencies \_\_\_\_ deficiency (scurvy)
vitamin
vitamin C
Workgroup 1
3.7 Traumatic lesions
Physical/mechanical insults: ____
Chemical (toxics) insults: ____ Thermal insults: ____ of mucosa
tooth brushing
chlorhexidine
burns
Workgroup 1
3.8 Gingival pigmentation ____
____-induced pigmentation ____ tattoo
smoker’s melanosis
drug
amalgam
Periodontitis
- ____ diseases
- ____
- periodontitis as a manifestation of ____
necrotizing periodontal
periodontitis
systemic disease
Workgroup 2
____ categories of Necrotizing Periodontal Disease
three
Workgroup 2
1.1 Necrotizing gingivitis
Acute inflammatory process of the ____ tissues
gingival
Workgroup 2
- 1 Necrotizing gingivitis
- ____ of the interdental papillae
- Gingival bleeding
- ____
- Halitosis
- ____
- Regional lymphadenopathy - Fever
necrosis/ulcer
pain
pseudomembranes
Workgroup 2
1.2 Necrotizing periodontitis
Inflammatory process of the ____
periodontium
Workgroup 2
- 2 Necrotizing periodontitis
- Necrosis/ulcer of the interdental papillae
- Gingival bleeding
- Pain
- Halitosis
- Pseudomembranes
- Regional lymphadenopathy - Fever
- ____ loss
rapid bone
Workgroup 2
1.3 Necrotizing stomatitis
____ inflammatory condition of the periodontium
severe
Workgroup 2
- 3 Necrotizing stomatitis
- Necrosis/ulcer extends ____ the gingiva
- Gingival bleeding
- Pain
- Halitosis
- Pseudomembranes
- Regional lymphadenopathy - Fever
- ____ in the alveolar mucosa
- ____ and bone sequestrum
beyond
bone denudation
osteitis
Workgroup 2
____ categories of Necrotizing Periodontal Disease
Host immune impairment:
- ____
- Malnutrition
- ____ infections
- Stress
three
immunosuppression
viral
Workgroup 2
Three categories of Necrotizing Periodontal Disease
- ____
- ____
- ____
papilla necrosis
bleeding
pain
Workgroup 2
Stages (I, II, III, IV)
Severity of the disease
- ____ loss
- Radiographic bone loss
- ____ loss
Complexity of disease management
- ____
- Horizontal bone loss
- ____ loss
- Furcation involvement
- ____ mobility
- Ridge deficiencies
- ____ dysfunction
clinical attachment
tooth
probing depth
vertical bone
tooth
masticatory
We are going to talk about general (dont understand..sorry). And we are going to mention it later on , so you can be more familiarized with the classification. Typically, when we talk about stage I and II, we talk about ____mm of attachment loss, more than ____ is stage III and IV. The radio graphical bone loss uses guidelines.
When he came back to this: In terms of the tooth, stage I and II, there is no tooth loss due to periodontitis. In stage III, you have ____ loss , less than 4. In stage IV, you have more than ____ teeth loss due to periodontitis.
In terms of complexity, for stages 1-2 , mainly ____ bone loss and stage III we have also ____ bone loss and ____ involvement.
In stage IV, there is a more advanced scenario. It’s complex. Its ____, bite collapse, less than 10 teen remaining in the patient. They need a complex treatment, prosthetically and periodontically.
1-4
5
tooth
5
horizontal
vertical
furcation
malocclusion
They divide the roots into thirds. Coronal, middle, and apical third and based on that they look to see where bone loss is located and they say if its in the coronal third, its in stage ____. If its in the middle third its in stage ____
I and II
III and IV
Workgroup 2
Extent and distribution
Localized (____%)
____ pattern
30
30
molar-incisor
Workgroup 2
Degree (A,B,C)
Disease progression
Direct evidence
- ____
- RBL
Indirect evidence
- % ____
- phenotype
Risk factors
- ____
- diabetes
CAL
bone loss/age
smoking
Workgroup 2
With direct evidence, we have the phenotype that is more ____, so we see the patient and have little plaque or calculus or almost none and there is a lot of bone loss, mobility severe, then it is not directly proportional to the amount of dental plaque for the clinical scenario that the patient has is grad ____.
To the contrary, if we see a lot of dental plaque and calculus and its light bone loss, we put it under the category of grade ____. The risk modifies, smoking and diabetes, we give them grade A-no smoker no diabetes, B-less than ____ cigs a day, and C-mor than ____ cigs a day. And for diabetes, less than ____ HbA1c and more than 7.0 HbA1c for people with grade C.
So if the patient bone attachment loss did not change in 5 years, but the patient smokes a lot, more than 10 cigs, then we go to grade ____. So we always look for the most advanced factor that can be contributing to the periodontal
Condition.
subjective
C
A
10
10
7.0
C
Other conditions affecting the periodontium
- ____ diseases affecting the Periodontium
- ____ and Endodontic-Periodontal Lesions
- ____ Deformities
- ____ Occlusal Forces
- ____ and Tooth Related Factors
systemic periodontal mucogingival traumatic prosthesis
Other conditions affecting the periodontium
- ____ diseases affecting the Periodontium
- ____ and Endodontic-Periodontal Lesions
- ____ Deformities
- ____ Occlusal Forces
- ____ and Tooth Related Factors
systemic periodontal mucogingival traumatic prosthesis
Workgroup 3
Disorder:
Down syndrome
Strength of association
- ____
moderate
Workgroup 3
Disorder; strength of association
- obesity; ____
- diabetes mellitus; ____
- osteoporosis; ____
significant
significant
significant
Workgroup 3
periodontal abscesses
Localized ____ accumulation
Within the wall of the ____/sulcus
Significant ____ breakdown
pus
periodontal pocket
tissue
Workgroup 3
Periodontal abscesses
- ____ elevation (gingiva and lateral part of the root)
- Bleeding on probing
- ____
- Suppuration
- Deep ____
- Tooth mobility
ovoid
pain
periodontal pocket
Workgroup 3
Periodontal abscesses in periodontitis patients
Untreated patients: (____)
Treated patients:
- After scaling and root planning (remaining ____)
- After periodontal surgery (____, membranes)
- Systemic antimicrobial (without ____ debridement)
periodontal pocket
calculus
sutures
subgingival
Workgroup 3
Periodontal abscesses in non-periodontitis patients
Healthy sites:
- Impaction of ____ (dental floss, popcorn)
- Harmful ____ (nail biting, biting wire)
- ____ factors (inadequate orthodontic forces)
- Gingival ____
foreign bodies
habits
orthodontic
enlargement
Workgroup 3
Endodontic Periodontal Lesions
____ communication between the pulpal and periodontal tissue
pathologic
Workgroup 3
Endodontic periodontal lesions
- Deep periodontal pocket extending to the ____ (primary sign)
- Negative/altered response to ____ tests
- Radiographic evidence of ____ in the apical or furcation region
root apex
pulp vitality
bone loss
Workgroup 3
Endodontic Periodontal lesions
- ____ pain
- Pain on palpation/percussion
- Purulent ____/suppuration
- Tooth mobility
- ____/fistula
- Crown and/or gingival color alterations
spontaneous
exudate
sinus tract
Workgroup 3
Endodontic Periodontal Lesions
Perio-endo ifnection Caries > \_\_\_\_ Periodontitis > \_\_\_\_ Periodontitis > \_\_\_\_ CHRONIC
Trauma and iatrogenic factors \_\_\_\_ or cracking root canal or pulp chamber perforation \_\_\_\_ root resorption ACUTE
periodontium
root canal
caries
root fracture
external
Workgroup 3
Mucogingival deformities and conditions around teeth
1. Periodontal biotype Thin scalloped biotype: - \_\_\_\_ triangular crown - \_\_\_\_ cervical convexity - Interproximal contacts close to the \_\_\_\_ - \_\_\_\_ KT - \_\_\_\_ gingiva - \_\_\_\_ alveolar bone
slender subtle incisal edge narrow thin thin
Workgroup 3
Mucogingival deformities and conditions around teeth
1. Periodontal biotype Thick flat biotype: - \_\_\_\_-shape tooth crowns - \_\_\_\_ cervical convexity - Interproximal contacts more \_\_\_\_ - \_\_\_\_ zone of KT - \_\_\_\_ gingiva - \_\_\_\_ alveolar bone
square pronounced apical broad thick thick
Workgroup 3
Mucogingival deformities and conditions around teeth
- Gingival / soft tissue recession
- ____, lingual surfaces, ____
facial
interproximally
Workgroup 3
Mucogingival deformities and conditions around teeth
- Gingival / soft tissue recession - Severity of recession (Cairo Classification) Recession Type 1 (RT1):
Gingival recession with no loss of ____
____ is clinically not detectable at both mesial and distal aspects of the tooth
interproximal attachment
interproximal CEJ
Workgroup 3
Mucogingival deformities and conditions around teeth
- Gingival / soft tissue recession - Severity of recession (Cairo Classification)
Recession Type 2 (RT2):
____ recession associated with loss of ____
Interproximal AL is less than or equal to the ____
gingival
interproximal attachment
buccal attachment loss
Workgroup 3
Mucogingival deformities and conditions around teeth
- Gingival / soft tissue recession - Severity of recession (Cairo Classification)
Recession Type 3 (RT3):
Gingival recession associated with loss of ____
Interproximal AL is ____ than the buccal attachment loss
interproximal attachment
greater
Workgroup 3
Mucogingival deformities and conditions around teeth
- Gingival / soft tissue recession
- Gingival thickness = ____ mm
1
Workgroup 3
Mucogingival deformities and conditions around teeth
- Gingival / soft tissue recession - Gingival width = ____ mm
- Lack of ____ gingiva
- Decreased ____ depth
- Aberrant ____/muscle position
- Gingival ____
2 keratinized vestibular frenum excess
Workgroup 3
Traumatic occlusal forces
primary occlusal trauma > ____ occlusal forces (tooth/teeth) > normal ____ support:
- ____ CAL
- ____ BL
excessive
periodontal
normal
normal
Workgroup 3
Traumatic occlusal forces
Secondary occlusal trauma > ____ occlusal forces (tooth/teeth) > ____ periodontal support:
- ____ loss
- ____ loss
normal/excessive
reduced
clinical attachment
bone
Workgroup 3
Traumatic occlusal forces
Clinical and radiographic indicators of occlusal trauma
- ____
- Mobility
- ____ discrepancies
- Wear facets
- Tooth ____
- Fractured tooth
- ____ sensitivity
- Discomfort / pain on chewing
- Widened ____ space
- Root resorption
- ____ tear
fremitus occlusal migration thermal PDL cemental
Workgroup 3
Localized tooth related factors
- Tooth anatomic factors
- ____ projections
- Developmental ____ groove - Root ____
- Cervical root resorption, cemental tears
- Root ____
- Altered passive eruption
cervical enamel
palatal
fractures
proximity
Workgroup 3
Localized dental prosthesis related factors
- Restoration margins placed within the ____ attached tissues
- Clinical procedures related to the fabrication of ____ restorations
- Hypersensitivity / toxicity reactions to ____
supracrestal
indirect
dental material
Peri-Implant Diseases and Conditions
- Peri-Implant ____
- Peri-Implant ____
- ____
- Peri-Implant ____ Tissue Deficiencies
health
mucositis
implantitis
soft and hard
Workgroup 4
Peri-implant health
- Masticatory and lining ____
- Mucosa averages high ____mm from mucosal margin to the crest of the peri-implant bone
- Papilla height between an implant-supported restoration and natural tooth is ≤ ____ mm
mucosa
3-4
5
Workgroup 4
Peri-implant Health
- Following implant, ____mm of bone occurs
- PD > ____mm mm and/or crestal bone loss ≥ ____mm mm should be investigated for pathology
- After this initial period 75% of implants experience no additional ____mm
5
2
bone loss
Workgroup 4
Peri-implant Mucositis
- ____
- ____ weeks for resolution
reversible
3
Workgroup 4
Peri-implant Mucositis
- Predisposing factors: ____, cement
- Plaque accumulation results in more severe ____ response around implants compared to natural teeth
plaque
inflammatory
Workgroup 4
Peri-implantitis
- Difficult to define what is the normal ____ range around implants
- Hx of ____ disease is a risk factors for peri-implantitis
- Data for smoking and diabetes is ____
PD
periodontal
inconclusive
Workgroup 4
Peri-implantitis
- Compliance with ____ interval reduces the risk of peri-implantitis
- ____: potential risk factor
- No evidence that ____ is a risk factor peri-implantitis
maintenance
cement
occlusal overload
So a patient with peri-implant health has no inflammation, no bleeding, and there isn’t an increase in probing depth in future visits.The patient is stable. There is no more bone loss after the initial bone remodeling.
Peri-implant mucositis has ____, ____ , ____, but no ____. For peri-implantitis we have all 4 of them.
inflammation
BOP
probing depth
bone loss
Good (one or more of the following) • Adequate periodontal \_\_\_\_ (clinically and radiographically) • \_\_\_\_ to maintain • Adequate patient \_\_\_\_ • Control of the \_\_\_\_ factors
support
easy
cooperation
etiologic
Fair (one or more of the following)
• Approximately ____% attachment loss (clinically and radiographically)
• ____ furcation involvement / Proper maintenance
• Acceptable patient ____
25
class I
cooperation
Poor (one or more of the following)
• ____% attachment loss (clinically and radiographically)
• ____ furcation involvement / Proper maintenance with difficulty
50 class II
Questionable (one or more of the following)
- Greater than ____% attachment loss (clinically and radiographically)
- Poor ____ ratio
- ____ furcation not easily accessible
- ____ furcation
- Mobility Grade ____ or greater
- Significant root ____
50 crown-to-root class II class III 2 proximity
Hopeless
• Inadequate ____ to maintain the tooth
• ____ performed or suggested
attachment
extraction
